Diagnostic Accuracy of B-Mode- and Contrast-Enhanced Ultrasound in Differentiating Malignant from Benign Pleural Effusions

Purpose: To evaluate the value of CEUS in differentiating malignant from benign pleural effusions (PEs). Methods: From 2008 to 2017, 83 patients with PEs of unknown cause were examined using B-mode thoracic ultrasound (B-TUS), CEUS, and cytological examination. The extent of enhancement of the pleural thickening, the presence of enhancement of septa or a solid mass within the PE, and the homogeneity of the enhancement in the associated lung consolidation, were examined. Subsequently, the diagnostic value of cytology, B-TUS, and CEUS in differentiating malignant from benign PEs was determined. Results: With CEUS, markedly enhanced pleural thickening and inhomogeneous enhanced lung consolidation were significantly more frequently associated with malignancy (p < 0.05). In the subgroup analysis, the use of CEUS increased the sensitivity from 69.2 to 92.3 in patients with initial negative cytology but clinical suspicion of malignant PE; it also increased the specificity from 63.0 to 90.0, the positive predictive value from 69.2 to 92.3, the negative predictive value from 63.0 to 90.0, and the diagnostic accuracy from 66.7 to 87.5, in the evaluation of PE malignancy. Conclusion: The use of clinically based B-TUS and CEUS as a complementary method to cytological evaluation may be beneficial for evaluating a PE of unknown cause. CEUS patterns of enhanced pleural thickening and inhomogeneous enhanced lung consolidation may suggest a malignant PE.

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Should Contrast-Enhanced Harmonic Endoscopic Ultrasound Be Incorporated into the International Consensus Guidelines to Determine the Appropriate Treatment of Intraductal Papillary Mucinous Neoplasm?

Journal of Clinical Medicine ◽

10.3390/jcm10091818 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1818

Author(s):

Tomohiro Yamazaki ◽

Mamoru Takenaka ◽

Shunsuke Omoto ◽

Tomoe Yoshikawa ◽

Rei Ishikawa ◽

...

Keyword(s):

Intraductal Papillary Mucinous Neoplasm ◽

Predictive Value ◽

Diagnostic Value ◽

Consensus Guidelines ◽

International Consensus ◽

Mucinous Neoplasm ◽

Appropriate Treatment ◽

Contrast Enhanced ◽

Diagnostic Values ◽

International Consensus Guidelines

This study aimed to investigate whether the incorporation of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) into the international consensus guidelines (ICG) for the management of intraductal papillary mucinous neoplasm (IPMN) could improve its malignancy diagnostic value. In this single-center retrospective study, 109 patients diagnosed with IPMN who underwent preoperative CH-EUS between March 2010 and December 2018 were enrolled. We analyzed each malignancy diagnostic value (sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV)) by replacing fundamental B-mode EUS with CH-EUS as the recommended test for patients with worrisome features (WF) (the CH-EUS incorporation ICG) and comparing the results to those obtained using the 2017 ICG. The malignancy diagnostic values as per the 2017 ICG were 78.9%, 42.3%, 60.0%, and 64.7% for Se, Sp, PPV, and NPV, respectively. The CH-EUS incorporation ICG plan improved the malignancy diagnostic values (Se 78.9%/Sp, 53.8%/PPV, 65.2%/NPV 70.0%). CH-EUS may be useful in determining the appropriate treatment strategies for IPMN.

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Diagnostic Accuracy of Sonographic Septations in Tuberculous and Malignant Pleural Effusions

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v9i2.339 ◽

2020 ◽

Vol 9 (2) ◽

pp. 95-102

Author(s):

Abdul Rasheed Qureshi ◽

Muhammad Irfan ◽

Zeeshan Ashraf

Keyword(s):

Pleural Effusion ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Tertiary Care ◽

Positive Likelihood Ratio ◽

Fisher Exact Test ◽

Care Hospital ◽

Pleural Effusions ◽

Malignant Pleural Effusions ◽

Malignant Group

Background: Discrimination between tuberculous (TB) and malignant pleural effusions is a real practical challenge because both exist as exudative lymphocytic type. Transthoracic ultrasonography not only identifies and quantifies pleural effusion but also displays sonographic septations, which are frequently seen in TB pleural effusions and can help in differentiation between tuberculosis and malignancy successfully, without any invasive procedure. We designed this study to determine the diagnostic usefulness of these septations for tuberculous and malignant pleural effusions. Material and Methods: This prospective study was conducted in the OPD of Gulab Devi Chest Hospital Lahore, Pakistan, a 1500 bedded tertiary care hospital, from November 2016 to February 2018. Total of 339 consecutive cases, aged 14-83 years with radiological evidence of pleural effusion were included in the study. After detailed history, thorough physical examination, radiological, haematological and biochemical findings were recorded. Pleural fluid macroscopic, cytological, microbiologic and biochemical analysis results were also recorded. Ultrasonography was done, septated and non-septated pleural effusions identified and findings were noted. SPSS-16 was used for statistical evaluation. Fisher Exact test was utilized for comparison between TB and malignant cases with P-value < 0.05 taken as significant. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and positive likelihood ratio were calculated. Results: Out of total 339 cases, 49 (14.45%) were malignant and 290 (85.55%) were non-malignant. In the malignant group, only 03 cases (6.12%) showed sonographic septations. In the non-malignant group, 259/290 (89.31%) cases showed tuberculous etiology and 187/259 (72.20%) of these cases displayed sonographic septations. By considering septations as predictor of TB, statistical analysis revealed a sensitivity of 79.23%, specificity of 92.85%, PPV of 98.42%, NPV of 44.31% and diagnostic accuracy of 81.29%, respectively. Conclusions: Sonographic septations can be a valuable predictor of tuberculosis, in a population with high prevalence of the disease. We found it to be a useful feature in differentiating between a malignant and tuberculous etiology, in exudative lymphocytic pleural effusions. It can be used with confidence in patients who are unfit for interventional procedures.

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Diagnostic value of contrast-enhanced ultrasound versus computed tomography for hepatocellular carcinoma: a retrospective, single-center evaluation of 234 patients

Journal of International Medical Research ◽

10.1177/0300060520930151 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052093015 ◽

Cited By ~ 2

Author(s):

Vincent Schwarze ◽

Constantin Marschner ◽

Wiebke Völckers ◽

Sergio Grosu ◽

Giovanna Negrão de Figueiredo ◽

...

Keyword(s):

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Predictive Value ◽

Diagnostic Value ◽

Ct Scans ◽

Liver Lesions ◽

Contrast Enhanced Ultrasound ◽

Single Center ◽

Experienced Radiologist ◽

Contrast Enhanced

Objective Hepatocellular carcinoma (HCC) is the most common cause of primary liver cancer. A major part of diagnostic HCC work-up is based on imaging findings from sonography, computed tomography (CT), or magnetic resonance imaging (MRI) scans. Contrast-enhanced ultrasound (CEUS) allows for the dynamic assessment of the microperfusion pattern of suspicious liver lesions. This study aimed to evaluate the diagnostic value of CEUS compared with CT scans for assessing HCC. Methods We performed a retrospective, single-center study between 2004 and 2018 on 234 patients with suspicious liver lesions who underwent CEUS and CT examinations. All patients underwent native B-mode, color Doppler and CEUS after providing informed consent. Every CEUS examination was performed and interpreted by a single experienced radiologist (European Federation of Societies for Ultrasound in Medicine and Biology level 3). Results CEUS was performed on all included patients without occurrence of any adverse effects. CEUS showed a sensitivity of 94%, a specificity of 70%, a positive predictive value of 93% and a negative predictive value of 72% for analyzing HCC compared with CT as the diagnostic gold standard. Conclusions CEUS has an excellent safety profile and shows a high diagnostic accuracy in assessing HCC compared with corresponding results from CT scans.

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Role of contrast enhanced computed tomography in assessing cervical lymph node metastases in oral cavity squamous cell carcinoma

Journal of the Pakistan Medical Association ◽

10.47391/jpma.594 ◽

2021 ◽

pp. 1-10

Author(s):

Talha Ahmed Qureshi ◽

Muhammad Wasif ◽

Muhammad Sohail Awan ◽

Adnan yar Muhammad ◽

Ainulakbar Mughal ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Diagnostic Accuracy ◽

Ct Scan ◽

Cell Carcinoma ◽

Squamous Cell ◽

Predictive Value ◽

P Value ◽

Contrast Enhanced ◽

Kappa Value

Abstract Objectives: To evaluate the diagnostic accuracy of contrast enhanced CT scan to detect cervical nodal metastasis in oral cavity squamous cell carcinoma keeping final histopathology as gold standard. Methods: Cross sectional study conducted from 1st January 2015 - 31st October 2016. All patients undergoing surgery who had their CT scans done at our centre were included in the study. Diagnostic accuracy of CT scans was calculated using final histopathology as gold standard. All CT scan were reviewed by consultant radiologist. Results: Total 100 patients were reviewed, 70% were female, 55% had buccal and 32% had tongue cancer. 11 cases of T1, 20 cases of T2 , 4 cases of T3 and 21 cases of T4 stages were staged similarly by CT scan and histopathology, the kappa value of38.8%, p value <0.01. 6 cases of N1, 1 case of N2a , 9 cases of N2b, 3 cases of N2c, 1 case of N3 and 29 cases of N0 stages were staged similarly by CT scan and histopathology, with kappa value of 28.1%, p value of <0.01. Sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy were 83%,61%,70.9%,76.3% and 73% respectively. Conclusion: CT scan is useful for preoperative staging of oral cavity squamous cell carcinoma with an overall diagnostic accuracy of 73%, currently there are no superior diagnostic modalities. However, Due to low specificity and negative predictive value elective neck dissection should still be done in a negative CT scan for cervical lymph node metastases. Keywords: Oral Cavity,

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Diagnostic value of virtual autopsy using pm-MRI at 3T on malformed second trimester fetuses vs classic autopsy

PLoS ONE ◽

10.1371/journal.pone.0260357 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260357

Author(s):

Adelina Staicu ◽

Camelia Albu ◽

Roxana Popa-Stanila ◽

Cosmina Ioana Bondor ◽

Ioana Cristina Rotar ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Diagnostic Value ◽

Kappa Coefficient ◽

Termination Of Pregnancy ◽

Diagnostic Utility ◽

Second Trimester ◽

Virtual Autopsy ◽

Group A ◽

Cardiac Group

Objective To determine the diagnostic value of virtual autopsy using post mortem-MRI (pm-MRI) at 3Tesla (T) compared to classic autopsy for the confirmation of fetal structural anomalies and secondly to establish which cases of termination of pregnancy would benefit mostly from a virtual autopsy. Methods In each of 32 fetuses included in the study, 32 anatomical structures were assessed, after termination of pregnancy in the second trimester. All cases were evaluated by prenatal ultrasonography, virtual autopsy and classic autopsy, and then divided into four groups: Cerebral Group, Cardiac Group, Renal Group and Other Group (miscellaneous group). The concordance of virtual autopsy with classic autopsy was calculated overall and for each group and each structural item. Also, the concordance between the two methods was assessed using a diagnostic error score (DgE_score), calculated as the absolute value of the difference between the number of malformations detected by classic autopsy per case (CA score) and the number of malformations detected at virtual autopsy per case (VA score). Results Overall virtual autopsy demonstrated a diagnostic sensitivity (Se) compared to classic autopsy of 67.33% [95% CI 57.28–76.33], with a specificity (Sp) of 98.37% [95% CI 97.33–99.09], a positive predictive value (PPV) of 81.93% [95% CI 71.95–89.52], a negative predictive value (NPV) of 96.49% [95% CI 95.11–97.57] achieving a diagnostic accuracy of 95.31% [95% CI 93.83–96.52]. Overall, no statistic significant correlation was demonstrated between DgE_score and the gestational age of the fetuses or between DgE_score and the weight of the fetuses, but a significant correlation was revealed between the virtual autopsy and classic autopsy score. The diagnostic utility of virtual autopsy using pm-MRI at 3 T as compared to classic autopsy for each category of termination of pregnancy revealed in the Cerebral Group a Se of 80.00% [95% CI 28.36–99.49], with a 96.30% [95% CI 81.03–99.91], a PPV of 80.00% [95% CI 35.75–96.64] a NPV of 96.30% [95% CI 81.81–99.34], with a diagnostic accuracy of 93.75% [95% CI 79.19% to 99.23] and a Cohen’s Kappa coefficient of 0.76 [95% CI 0.4494–1.0765]; in the Renal Group a Se and Sp of 100%, but in the Cardiac Group the Se was only 60.00% [95% CI 26.24–87.84], Sp 75% [95% CI 34.91–96.81], the PPV 75.00% [95% CI 44.92–91.69], NPV 60% [95% CI 38.87–77.96], with a diagnostic accuracy of 66.67% [95% CI 40.99–86.66] and a Cohen’s Kappa coefficient of 0.32 [95% CI -0.07–0.76]. Conclusions The results support virtual autopsy using pm-MRI at 3T as a reliable alternative to classic autopsy for the non-forensic analysis of second trimester fetuses. Analyzing the diagnostic utility of virtual autopsy using pm-MRI at 3 T for the confirmation of prenatal ultrasound findings in second trimester fetuses as compared to classic autopsy, the best results were obtained in the Cerebral and Renal Group. Reserved results were found in the Cardiac Group. Therefore, for the pregnancies with termination of pregnancy for cerebral or renal abnormalities, virtual autopsy by pm-MRI at 3T can be taken into consideration as a first-line investigation to confirm the prenatal findings.

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Contrast Enhanced Mammography: The added value in the assessment of Suspicious Breast Lesions

QJM ◽

10.1093/qjmed/hcaa068.001a ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R Abdullah ◽

L Abdelmonem ◽

N Nasry ◽

M Ayoub

Keyword(s):

Breast Cancer ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Malignant Tumors ◽

High Energy ◽

Added Value ◽

Breast Lesions ◽

Predictive Values ◽

Dense Breasts ◽

Contrast Enhanced

Abstract Background Breast cancer in women is a major public health problem throughout the world, being the second most common cancer worldwide. Sonomammography has been always recommended as the basic breast imaging modality for early detection and diagnosis of breast cancer. Some malignant tumors have been missed, specially in dense breasts, and high false-negative rate have been reported. Contrast enhanced spectral mammography is a new modality, used to depict the tumor vascularity and neoangiogenesis; a classic sign of malignant tumors. Aim of Work The purpose of this study is to determine the added value of dual energy contrast mammography to sono-mammography in the assessment of suspicious breast lesions. Patients and Methods 36 patients were included in the study, referred from outpatient clinics in private settings and from Demerdash Hospitals. Contrast enhanced spectral mammography CESM was performed by using a digital mammography unit (Seno DS; GE, Buc, France) that had been adapted to obtain two images for each view: a low-energy image (below the k edge of iodine, 33.2 keV) and a high-energy image (above the k edge of iodine) at 45 to 49 kVp. Results: CEDM versus sonomammography shows p (0.021) value less than 0.05. Also the area under the ROC curve was higher for MX+CEDM (94.4%) than that was for sonomammography (63.8%) compared to pathology analysis with 100% sensitivity, 88.2 % specificity, 90.48 %PPV and 100 % NPV in diagnosis of suspicious lesions. Conclusion The diagnostic accuracy of CEDM+ MX for the detection of breast carcinoma has proven to be superior to sonomammography alone. CEDM had a better diagnostic accuracy mainly due to improved positive and negative predictive values (Positive predictive value about 90.48, negative predictive value 100). The role of CEDM in detection of multifocal / multicentric carcinomas with particular interest for the assessment of the extent of disease specially in dense breasts is appreciated.

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The Value of Contrast-Enhanced Ultrasound Classification in Diagnosis of Pancreatic Cystic Lesions

BioMed Research International ◽

10.1155/2019/5698140 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Yixi Wang ◽

Yanjie Wang ◽

Zhihui Fan ◽

Jun Shan ◽

Kun Yan

Keyword(s):

Diagnostic Accuracy ◽

Diagnostic Value ◽

Type I ◽

Cystic Lesions ◽

Type Ii ◽

Contrast Enhanced Ultrasound ◽

Type Iii ◽

Type Iv ◽

Contrast Enhanced ◽

Significant Difference

Objective. To compare the consistency of contrast-enhanced ultrasound (CEUS) classification results with magnetic resonance imaging (MRI) and to investigate the diagnostic value of CEUS classification in pancreatic cystic lesions. Methods. 84 cases of pancreatic cystic lesions were enrolled in this study. According to the CEUS classification methods of previous study in our center, all the lesions were classified into four types: type I, unilocular cysts; type II, microcystic lesions; type III, macrocystic lesions; and type IV, cystic lesions with enhanced solid components. The consistency of CEUS and MRI typing results was analysed. Among the 84 cases, 45 cases had pathological results. The CEUS results were compared with the pathological results, and the diagnostic value of CEUS classification in diagnosing pancreatic cystic lesions was explored. Results. Among the 84 cases, CEUS diagnosed 8 cases of type I, 24 of type II, 8 of type III, and 45 of type IV. MRI diagnosed 10 cases of type I, 25 of type II, 7 of type III, and 43 of type IV. The classification typing results of CEUS were highly consistent with that of enhanced MRI (kappa value: 0.852). Among the 45 cases with pathological results, the diagnostic accuracy of each type was 91.1%, 95.6%, 93.3%, and 88.9%. The accuracy of CEUS and MRI in diagnosing pancreatic cystic lesions was 75.56% (34/45) and 80% (36/45), respectively. The diagnostic accuracy of CEUS had no significant difference from that of MRI (P=0.687). Conclusion. The classification results by CEUS and MRI are in excellent agreement. The classification of pancreatic cystic lesions by CEUS is significantly helpful for clinical diagnosis.

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Diagnostic Value of Different Risk-Stratification Algorithms in Solid Breast Lesions

Applied Sciences ◽

10.3390/app10196943 ◽

2020 ◽

Vol 10 (19) ◽

pp. 6943

Author(s):

Ivana Eremici ◽

Catalin Dumitru ◽

Dan Navolan ◽

Marius Craina ◽

Viviana Ivan ◽

...

Keyword(s):

Risk Stratification ◽

Predictive Value ◽

Breast Imaging ◽

Strain Ratio ◽

Diagnostic Value ◽

Case Scenario ◽

Worst Case ◽

Complementary Method ◽

Worst Case Scenario ◽

Histopathological Results

In the past few years, elastography has gained ground as a complementary method to ultrasonography in noninvasive breast cancer screening. Despite positive outcomes, there is a further need to refine the method, especially regarding BIRADS scores 3 and 4A, where the distinction between benignancy and malignancy is established. The aim of the present study was to evaluate the best risk-stratification system using both qualitative and semiquantitative elastographic methods for solid breast nodules. A total of 1405 solid nodules, described in 657 female patients, were examined in our endocrine unit between January 2018 and December 2019. The inclusion criterion for our retrospective study was the presence of any solid breast mass in women of all ages (mean, 40.85 ± SD 27.11), detected during ultrasound examination using a HITACHI PREIRUS machine (Hitachi Medical Corporation, Tokyo, Japan). The Breast Imaging Reporting and Data System (BIRADS)–US criteria were used in the assessment of each nodule by conventional US (gray-scale mode) and Doppler evaluation. The Ueno score and strain ratio were also measured for all the described lesions. We considered multiple algorithms for the risk reassessment of solid breast nodules: classical BIRADS–US, EFSUMB BIRADS, worst-case scenario BIRADS and BIRADS TM. There were 93 malignant nodules out of 1405. The diagnosis was based on histopathological results for all the malignant lesions. Benign lesions were diagnosed based on histopathological results, Tru-Cut biopsy, mammography and MRI. The Sensitivity (Se), Specificity (Sp), Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Accuracy (Acc) were obtained for all the proposed risk-stratification reporting systems: conventional BIRADS-US (Se, 74.23%; Sp, 63.95%; PPV, 13.53%; NPV, 97.79%; Acc, 65%); EFSUMB BIRADS (Se, 71.23%; Sp, 81.55%; PPV, 22.68%; NPV, 97.99%; Acc, 81%); worst-case scenario BIRADS (Se, 84.23%; Sp, 58.23%; PPV, 13.29%; NPV, 98.84%; Acc, 60%); BIRADS TM (Se, 81.23%; Sp, 75.84%; PPV, 20.35%; NPV, 98.81%; Acc, 77%). We found that the most efficient risk-stratification reporting system was the proposed one, BIRADS TM, which considers both upgrading and downgrading the conventional BIRADS-US, followed by the worst-case scenario BIRADS and EFSUMB BIRADS.

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The diagnostic accuracy of wrist cineradiography in diagnosing scapholunate dissociation

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413489056 ◽

2013 ◽

Vol 39 (3) ◽

pp. 263-271 ◽

Cited By ~ 20

Author(s):

G. S. I. Sulkers ◽

N. W. L. Schep ◽

M. Maas ◽

C. M. A. M. van der Horst ◽

J. C. Goslings ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Diagnostic Value ◽

Inclusion Criteria ◽

Scapholunate Ligament ◽

Scapholunate Dissociation ◽

Post Test ◽

Sensitivity Specificity ◽

Post Test Probability ◽

Test Probability

Ruptures of the scapholunate ligament (SLL) may cause carpal instability, also known as scapholunate dissociation (SLD). SLD may lead to osteoarthritis of the radiocarpal and midcarpal joints. The aim of this retrospective study was to determine the diagnostic value of wrist cineradiography in detecting SLD. All cineradiographic studies made during a 24 year period were retrieved. All patients who underwent the confirmation method (arthroscopy and/or arthrotomy) and cineradiography were included. In total, 84 patients met the inclusion criteria. Sensitivity, specificity, likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy for detecting SLD were calculated for radiography and cineradiography. Cineradiography had a sensitivity of 90%, a specificity of 97%, and a diagnostic accuracy of 0.93 in detecting SLD. Radiography had a sensitivity of 81%, a specificity of 80%, and a diagnostic accuracy of 0.81. Cineradiography has a high diagnostic value for diagnosing SLDs. A positive cineradiography markedly increases the post-test probability of SLD.

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Potential diagnostic value of pleural fluid cytokines levels for tuberculous pleural effusion

Scientific Reports ◽

10.1038/s41598-020-79685-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Neda Dalil Roofchayee ◽

Majid Marjani ◽

Neda K. Dezfuli ◽

Payam Tabarsi ◽

Afshin Moniri ◽

...

Keyword(s):

Differential Diagnosis ◽

Pleural Effusion ◽

Diagnostic Accuracy ◽

Pleural Fluid ◽

Diagnostic Value ◽

Parapneumonic Effusion ◽

Pleural Effusions ◽

Tuberculous Pleural Effusion ◽

New Biomarkers ◽

High Level

AbstractPatients with tuberculous pleural effusion (TPE) or malignant pleural effusions (MPE) frequently have similar pleural fluid profiles. New biomarkers for the differential diagnosis of TPE are required. We determined whether cytokine profiles in the PE of patients could aid the differential diagnosis of TPE. 30 patients with TPE, 30 patients with MPE, 14 patients with empyema (EMP) and 14 patients with parapneumonic effusion (PPE) were enrolled between Dec 2018 and 2019. The levels of interleukin (IL)-6, IL-18, IL-27, CXCL8, CCL-1 and IP-10 were determined in PE by ELISA along with measurements of adenosine deaminase (ADA). The best predictors of TPE were combined ADA.IL-27 [optimal cut-off value = 42.68 (103 U ng/l2), sensitivity 100%, specificity 98.28%], ADA [cut off value 27.5 (IU/l), sensitivity 90%, specificity 96.5%] and IL-27 [cut-off value = 2363 (pg/ml), sensitivity 96.7%, specificity 98.3%, p ≤ 0.0001]. A high level of IL-6 [cut-off value = 3260 (pg/ml), sensitivity 100%, specificity 67.2%], CXCL8 [cut-off value = 144.5 (pg/ml), sensitivity 93.3%, specificity 58.6%], CCL1 [cut-off value = 54 (pg/ml), sensitivity 100%, specificity 70.7%] and IP-10 [cut-off value = 891.9 (pg/ml), sensitivity 83.3%, specificity 48.3%] were also predictive of TPE. High ADA.IL-27, ADA and IL-27 levels differentiate between TPE and non-TPE with improved specificity and diagnostic accuracy and may be useful clinically.

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